If you watch the video of the game where Kuroda is hit by the ball (see link below) you will see him pitch a ball that comes back at high speed and hits him on the right side of his head. He falls to the ground on this left and there is a brief moment where his head can be seen ricocheting toward the ground and back. This is likely where his neck injury started. This moment is an example of a side-impact “whiplash.” “Whiplash” itself is not an official diagnosis, but a term used when the head is flung too far in any one direction, and too abruptly. This most often occurs in an auto accident, but also when you get hit in the head by a ball going 90 miles per hour. This kind of injury, not uncommonly, leads to a herniated disc in the neck. Why does this happen? That requires a brief description of what a disc is and what does it mean when it herniates.

Our neck (or cervical spine) has seven bones called vertebrae stacked on top of each other. In between these bones is a cushion we call the disc. The disc is kind of like a stale jelly doughnut. It is firm on the outside and gooey in the center. This makes it great for shock absorption. When you tilt your head to the left, for example, you are putting more pressure on the left side of the disc. Now if you do it like Kuroda did, really really really fast, imagine how much more force is going to go into the disc. Probably more force than it can handle and it is likely to be damaged. So, what happens when the outside of a jelly doughnut, gets damaged? The jelly oozes out. That is essentially what a herniation is. This can be very painful when it puts pressure on the large spinal nerve root nearby.

Why, then, was it weeks later, while running, that Kuroda suffered such intense neck pain? A likely scenario is that the disc was damaged significantly when he was hit by the baseball but didn’t completely rupture. Not until, the bobbing of his head while running, last-straw-like finished it off.

Treatment for this injury varies depending on severity. Some times simple rest is recommended, other times Physical Therapy is prescribed and when conservative treatment fails, surgery can be done. Luckily for Kuroda, he is young, his disc injury was small, and he is back in the game.

To learn more about Herniated Discs, how they are diagnosed and treated click this link: http://www.cumc.columbia.edu/dept/nsg/ct/hidd.html.

Read the USA Today article: Kuroda hit by Line Drive

Photo by Ross D. Fanklin, AP

Here is a great Animated Video about the Cervical

Spine. You can see that as the head rocks side to side pressure on the disc shifts from right to left.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

What are the different types of head injury?

The following are some of the different types of head injuries:

• Concussion
  A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.
• Skull fracture
  A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:

Linear skull fractures
This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.

Depressed skull fractures
This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.

Diastatic skull fractures
These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.

Basilar skull fracture
This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.

• Intracranial hematoma (ICH)
  There are several types of ICH, or blood clots, in or around the brain. The different types are classified by their location in the brain. These can range from mild head injuries to quite serious and potentially life-threatening injuries. The different types of ICH include the following:

Epidural hematoma
Epidural hematomas occur when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain. They usually come from a tear in an artery that runs just under the skull called the middle meningeal artery. Epidural hematomas are usually associated with a skull fracture.

Subdural hematoma
Subdural hematomas occur when a blood clot forms underneath the skull and underneath the dura, but outside of the brain. These can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. They are sometimes, but not always, associated with a skull fracture.

Contusion or intracerebral hematoma
A contusion is a bruise to the brain itself. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck. Contusions may occur with skull fractures or other blood clots such as a subdural or epidural hematoma.

Diffuse axonal injury (DAI)
These injuries are fairly common and are usually caused by shaking of the brain back and forth, which can happen in car accidents or from falls. Diffuse injuries can be mild, such as with a concussion, or may be very severe, as in diffuse axonal injury (DAI). In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain.

Causes

There are many causes of head injury in children and adults. The most common injuries are from motor vehicle accidents (where the person is either riding as a passenger in the car or is struck as a pedestrian), from violence, from falls, or as a result of child abuse.

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a counter coup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

Symptoms

The person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head injury. However, each individual may experience symptoms differently. Symptoms may include:

• Mild head injury:
• raised, swollen area from a bump or a bruise
• small, superficial (shallow) cut in the scalp
• headache
• Moderate to severe head injury (requires immediate medical attention):
• confusion
• loss of consciousness
• blurred vision
• severe headache
• vomiting
• loss of short-term memory, such as difficulty remembering the events that lead right up to and through the traumatic event
• slurred speech
• difficult walking
• dizziness
• weakness in one side or area of the body
• sweating
• pale skin color
• seizures
• behavior changes including irritability
• blood or clear fluid draining from the ears or nose
• one pupil (dark area in the center of the eye) looks larger than the other eye
• deep cut or laceration in the scalp
• open wound in the head
• foreign object penetrating the head

The symptoms of a head injury may resemble other problems or medical conditions. Always consult your physician for a diagnosis.

Diagnosis

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Diagnostic tests may include:

• Blood tests
• X-ray — a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Computed tomography scan (also called a CT or CAT scan) — a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• Electroencephalogram (EEG) — a procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp. Magnetic resonance imaging (MRI) — a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Treatment

Specific treatment of a head injury will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the head injury
• Type of head injury
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the head injury
• Your opinion or preference

Depending on the severity of the injury, treatment may include:

• Ice
• Rest
• Topical antibiotic ointment and adhesive bandage
• Observation
• Immediate medical attention
• Stitches
• Hospitalization for observation
• Surgery

Treatment is individualized, depending on the extent of the condition and the presence of other injuries. If the patient has a severe head injury, he/she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

How is ICP monitored?

Intracranial pressure is measured in two ways. One way is to place a small hollow tube (catheter) into the fluid-filled space in the brain (ventricle). Other times, a small, hollow device (bolt) is placed through the skull into the space just between the skull and the brain. Both devices are inserted by the physician either in the intensive care unit (ICU) or in the operating room. The ICP device is then attached to a monitor that gives a constant reading of the pressure inside the skull. If the pressure goes up, it can be treated right away. While the ICP device is in place, the patient will be given medication to stay comfortable. When the swelling has gone down and there is little chance of more swelling, the device will be removed.

Life-long considerations for a person with a head injury:

The key is to promote a safe environment for children and adults and to prevent head injuries from occurring. The use of seat belts when riding in the car and helmets (when worn properly) for activities such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

Persons who suffer a severe brain injury may lose part(s) of muscle, speech, vision, hearing, or taste function, depending on the area of brain damage. Long- or short-term changes in personality or behavior may also occur. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the person’s recovery depends upon the type of brain injury and other medical problems that may be present. It is important to focus on maximizing the person’s capabilities at home and in the community. Positive reinforcement will encourage the patient to strengthen his/her self-esteem and promote independence.

In children, head trauma annually results in approximately 600,000 emergency department visits and 95,000 hospital admissions, and is the leading cause of traumatic death in children. One study of children with intracranial hemorrhages found that many children with serious injuries may have only mild symptoms and that those diagnosed early have a better outcome. Follow-up studies have confirmed these findings and have been directed at identifying the signs and symptoms of children who have more serious injuries to enable us to diagnose them as early as possible while avoiding unnecessary tests.

Treatment

Virtually all cranial gunshot victims are aggressively resuscitated upon initial arrival at the hospital. If a patient’s blood pressure and oxygenation can be maintained, an urgent CT scan of the brain is obtained. The decision to proceed with surgical management of the gunshot wound is based on three factors:

• The level of consciousness (GCS)
• The degree of brainstem neurological function
• The findings on the CT scan.

In virtually all patients who are deeply comatose with minimal evidence of brainstem function and no evidence of an intracranial hematoma that might be causing the coma, a fatal outcome is almost certain. In such patients, aggressive treatment is rarely pursued because of the futility of the situation. If, however, there is a hematoma seen on the CT scan, emergent craniotomy and clot evacuation may be warranted, as some of these individuals will make a significant recovery. For other patients who exhibit purposeful motor activity, urgent and aggressive neurosurgical care is provided, when indicated.

Prognosis

The predictors of poor neurological outcome or death after a gunshot wound to the head include

• Low initial Glasgow Coma Scale score
• Older age
• Presence of low blood pressure
• Inadequate oxygenation early after injury
• Dilated non-reactive pupils
• Not surprisingly, the bullet trajectory through the brain has major significance. Bullets that traverse the brainstem, multiple lobes of the brain, or the ventricular system (chambers where cerebrospinal fluid is located) are particularly lethal. Many initial survivors develop uncontrollable intracranial pressure and subsequently succumb.

Other congenital problems that may be treated by a pediatric neurosurgeon include:

• Chiari malformation, a condition in which portions of the base of the spine protrude into the upper spine, where they may compress the brain or spinal cord. Left untreated, this condition can lead to neck pain, hoarseness, upper-respiratory tract infections, and progressive weakness of the arms and legs. Chiari malformation also may block the flow of cerebrospinal fluid (CSF), leading to hydrocephalus. Treatments often focus on removing portions of the bone and soft tissue to relieve pressure on the spinal cord and brain, as well as providing new pathways to drain CSF. Encephaloceles is a condition similar to chiari malformation that affects the passageway between the nose and the front or back of the head.
• Encephaloceles can lead to infections and hydrocephalus. Surgical treatment of this condition involves removing bone and soft tissue or drainage of CSF.
• Tethered spinal cord, the attachment of the spinal cord to surrounding tissue. Failure to detect a tethered spinal cord can lead to a sudden catastrophic injury during childhood or adolescence, such as paralysis. Tethered spinal cord can be diagnosed through the detection of certain skin abnormalities along the midline of the back. Diagnosis may be confirmed by magnetic resonance imaging (MRI), and surgery is usually indicated to prevent neurological damage.